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Canadian results from the European Men-who-have-sex-with-men Internet survey (EMIS-2017). 欧洲男性网络调查(EMIS-2017)的加拿大结果。
N. Brogan, D. Paquette, N. Lachowsky, M. Blais, D. Brennan, T. Hart, B. Adam
BackgroundIn 2017, the international European Men-who-have-sex-with-men Internet Survey (EMIS-2017) collected data from 50 countries, including Canada for the first time.ObjectiveTo provide an overview of the Canadian EMIS-2017 data to describe the sexually transmitted and other bloodborne infection (STBBI) related needs of gay, bisexual and other men who have sex with men (gbMSM).MethodsThe EMIS-2017 questionnaire was an updated version of EMIS-2010. It included self-reported sociodemographic data, experience of discrimination, mental health and substance use, knowledge of preexposure prophylaxis (PrEP) for HIV, sexual practices and history of STBBI testing and diagnosis. Analysis was largely descriptive.ResultsOf the 6,059 respondents from Canada, 5,165 participants met the inclusion criteria for this analysis. The majority of participants were born in Canada (79.3%); and over half of the respondents (56.7%) were under the age of 39. In terms of discrimination related to their attraction to other men, participants reported high levels of intimidation (31.9%), verbal abuse (22.1%) and physical violence (1.5%) in the previous year. Regarding mental health, 23.9% had a moderate to severe depression/anxiety score. Almost two-thirds (64.1%) indicated substance use and one-fifth (21.5%) reported chemsex (or the use of stimulant drugs to make sex more intense or last longer). Only 8.4% of participants reported use of PrEP for HIV; however, 51.7% reported being likely to use PrEP if it was available and affordable. Sexual practices, such as condom use, varied by PrEP use with 91.3% of men using PrEP reporting condomless anal intercourse (CAI) compared with 71.5% of men not on PrEP. In terms of STBBI testing, 1.5% reported being diagnosed with hepatitis C and 9.0% reported an HIV diagnosis. Of those with an HIV diagnosis, most were on treatment (99.1%) and had an undetectable viral load (96.7%).ConclusiongbMSM in Canada experienced stigma, discrimination and mental health problems; substance use was high as were high-risk sexual practices, such as CAI, among some groups of men. There was a gap between the proportion of men who were interested in PrEP and those who actually used it; and comprehensive STBBI testing was low.These findings can inform public health action and provide a baseline to examine the impact of current and new interventions.
2017年,国际欧洲男性网络调查(EMIS-2017)首次收集了包括加拿大在内的50个国家的数据。目的概述加拿大EMIS-2017数据,以描述男同性恋、双性恋和其他男男性行为者(gbMSM)的性传播和其他血源性感染(STBBI)相关需求。方法EMIS-2017问卷为EMIS-2010的更新版。它包括自我报告的社会人口统计数据、歧视经历、精神健康和药物使用、艾滋病毒暴露前预防(PrEP)知识、性行为和STBBI检测和诊断史。分析主要是描述性的。结果在来自加拿大的6059名受访者中,5165名参与者符合本分析的纳入标准。大多数参与者出生在加拿大(79.3%);超过一半(56.7%)的受访者年龄在39岁以下。在与异性吸引相关的歧视方面,参与者报告说,在过去的一年中,她们受到了很高程度的恐吓(31.9%)、言语虐待(22.1%)和身体暴力(1.5%)。在心理健康方面,23.9%的人有中度至重度抑郁/焦虑评分。近三分之二(64.1%)的人表示使用药物,五分之一(21.5%)的人报告了化学性行为(或使用兴奋剂来使性生活更强烈或持续更长时间)。只有8.4%的参与者报告使用了预防艾滋病毒的PrEP;然而,51.7%的人表示,如果PrEP可用且价格合理,他们可能会使用PrEP。使用安全套等性行为因使用PrEP而异,使用PrEP的男性报告无套肛交(CAI)的比例为91.3%,而未使用PrEP的男性为71.5%。在STBBI检测方面,1.5%报告被诊断为丙型肝炎,9.0%报告被诊断为艾滋病毒。在被诊断为艾滋病毒的患者中,大多数人正在接受治疗(99.1%),病毒载量无法检测(96.7%)。结论加拿大男同性恋者存在污名化、歧视和心理健康问题;在某些男性群体中,药物使用率很高,高危性行为(如CAI)也很高。对PrEP感兴趣的男性比例与实际使用PrEP的男性比例存在差距;综合STBBI检测较低。这些发现可为公共卫生行动提供信息,并为审查当前和新的干预措施的影响提供基线。
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引用次数: 21
Increase in detection of Corynebacterium diphtheriae in Canada: 2006-2019. 2006-2019年加拿大白喉棒状杆菌检出率的增加
K. Bernard, A. L. Pacheco, T. Burdz, D. Wiebe
BackgroundIncreasingly, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) has been used to provide rapid, inexpensive and precise identification of bacteria, including Corynebacterium species. Only three Corynebacterium species are able to produce diphtheria toxin (DT), and strains recovered may be either toxin-producing or non-toxin-producing. It appears the more precise bacterial identification provided by MALDI-TOF systems has led to an increase in requests submitted to the National Microbiology Laboratory (NML) for toxin testing.ObjectiveTo describe the number of isolates identified as C. diphtheriae, C. ulcerans and C. pseudotuberculosis, submitted to the NML between January 2006 and July 30, 2019, including their geographic area, source, and whether they produce DT.MethodsReferrals to the NML of human or animal isolates that were identified as any of those three Corynebacterium species were studied with respect to province, source and toxigenicity. Species identification was confirmed and then specimens were tested by polymerase chain reaction for the presence of tox genes and, if positive, for expression of DT by the modified Elek method. Analysis was descriptive.ResultsOver the study period, 639 isolates were identified as C. diphtheriae, 22 isolates as C. ulcerans; no isolates were identified as C. pseudotuberculosis. There was an increase in C. diphtheriae referrals for DT testing: from eight per year in 2006 to an average of 15 per month in 2019, or a 1,200% increase over the 13.6-year period. The referrals were primarily from western Canada (n=609/639; 95%). Most (638/639, 99%) were human isolates and most were obtained from cutaneous sites. Of those isolates, 87/639 (13.6%) were found to be toxigenic and 552/639 (86.4%) non-toxigenic. Among C. ulcerans referrals, 17/22 (77%) were from humans and five (23%) were from animals, with 10/22 (45%) being toxigenic.ConclusionThere has been a marked increase in referrals to the NML for DT testing of Corynebacterium species. This could be due to the enhanced ability to identify these bacteria using MALDI-TOF systems. Ongoing monitoring will help to assess whether the increase is due solely to increased precision of diagnosis or whether these are emerging cutaneous pathogens.
越来越多的基质辅助激光解吸/电离飞行时间质谱(MALDI-TOF)被用于提供快速、廉价和精确的细菌鉴定,包括棒状杆菌种类。只有三种棒状杆菌能够产生白喉毒素(DT),并且恢复的菌株可能产生毒素或不产生毒素。MALDI-TOF系统提供的更精确的细菌鉴定似乎导致了向国家微生物实验室(NML)提交毒素检测请求的增加。目的了解2006年1月至2019年7月30日期间提交给NML的白喉、溃疡和假结核三种分离株的数量,包括其地理区域、来源和是否产生DT。方法对经鉴定为这3种棒状杆菌的人、动物分离株的NML进行省份、来源和毒力分析。确认物种鉴定,然后用聚合酶链反应检测标本是否存在tox基因,如果呈阳性,则用改进的Elek法检测DT的表达。分析是描述性的。结果在研究期间,鉴定出白喉支原体639株,溃疡支原体22株;未发现假结核杆菌分离株。转介进行白喉滴虫检测的病例有所增加:从2006年的每年8例增加到2019年的平均每月15例,在13.6年的时间里增加了1200%。转介者主要来自加拿大西部(n=609/639;95%)。大多数(638/639,99%)为人类分离株,多数来自皮肤部位。其中87/639株(13.6%)为产毒株,552/639株(86.4%)为非产毒株。其中17/22例(77%)来自人类,5例(23%)来自动物,10/22例(45%)为产毒菌。结论转到NML进行棒状杆菌种类DT检测的病例明显增加。这可能是由于使用MALDI-TOF系统识别这些细菌的能力增强。持续监测将有助于评估增加是否仅仅是由于诊断精度的提高,还是这些是新出现的皮肤病原体。
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引用次数: 20
Public health investigation of infection prevention and control complaints in Ontario, 2015-2018. 2015-2018年安大略省感染防控投诉公共卫生调查
G. Cadieux, C. Brown, H. Sachdeva
Background Following an update to the provincial Infection Prevention and Control Complaint Protocol in 2015, Ontario public health units have been mandated to investigate infection prevention and control (IPAC) complaints in various settings, including those where regulated health professionals work. No surveillance system exists for IPAC complaints; therefore, little is known about their occurrence. Anecdotal evidence suggests a recent increase in IPAC complaints resulting in increased demand on public health resources. Objectives To describe the occurrence of IPAC complaints and lapses in Ontario in 2015-2018 and the public health response to these. Methods Ontario public health units were surveyed about the occurrence and key challenges of IPAC complaint investigations through closed- and open-ended questions. The survey was disseminated through the Council of Ontario Medical Officers of Health listserv. Data collection spanned February 4-28, 2019. Descriptive statistical analyses and thematic analysis of free-text responses were performed. Results Twenty-one public health units responded for a 60% response rate; fewer responding health units had a population size of less than 100,000. A nearly six-fold increase in IPAC complaints was found, from a total of 79 complaints in 2015 to 451 in 2018. IPAC lapses nearly tripled, with 61 identified in 2015 and 168 in 2018. Whereas variation in the number of IPAC complaints and lapses among public health units was noted, the most common IPAC lapse involved inadequate reprocessing of reusable equipment. Key challenges in investigating IPAC complaints included lack of staff expertise/training, increased workload and costs, interjurisdictional inconsistencies and lack of guidance. Conclusion IPAC complaints and lapses have increased in Ontario since 2015 when the Ministry of Health and Long-Term Care changed the IPAC complaint protocol. Public health units identified lack of expertise, increased workload, interjurisdictional inconsistencies and lack of guidance as challenges. Further research to confirm these findings, identify best practices to address these challenges as well as interventions to prevent IPAC lapses would be useful. Prospective surveillance of IPAC complaints, like for reportable diseases, would also be useful.
在2015年更新了省级感染预防和控制投诉协议之后,安大略省公共卫生单位被授权调查各种环境中的感染预防和控制(IPAC)投诉,包括受监管的卫生专业人员工作的环境。没有监察投诉机构投诉的制度;因此,人们对它们的发生知之甚少。坊间证据表明,最近国际公共卫生委员会的投诉有所增加,导致对公共卫生资源的需求增加。目的了解安大略省2015-2018年IPAC投诉和疏漏的发生情况及公共卫生应对措施。方法通过封闭式和开放式问题对安大略省公共卫生单位进行调查,了解IPAC投诉调查的发生情况和面临的主要挑战。这项调查是通过安大略卫生保健医务人员委员会的网站进行传播的。数据收集时间为2019年2月4日至28日。对自由文本回复进行描述性统计分析和专题分析。结果21个公共卫生单位响应,响应率为60%;响应的卫生单位较少,人口规模不足10万人。IPAC的投诉增加了近六倍,从2015年的79起增加到2018年的451起。IPAC漏洞几乎增加了两倍,2015年发现61起,2018年发现168起。虽然注意到公共卫生单位对国际公共卫生计划的投诉和失误数量各不相同,但最常见的国际公共卫生计划失误涉及对可重复使用设备的再处理不足。调查国际公共事务委员会投诉的主要挑战包括工作人员缺乏专门知识/培训、工作量和费用增加、管辖间不一致和缺乏指导。结论自2015年卫生和长期护理部改变IPAC投诉协议以来,安大略省的IPAC投诉和失误有所增加。公共卫生单位认为,缺乏专门知识、工作量增加、辖区间不一致和缺乏指导是挑战。进一步研究以证实这些发现,确定应对这些挑战的最佳做法以及防止IPAC失误的干预措施将是有益的。对IPAC投诉的前瞻性监测,如对可报告疾病的监测,也将是有用的。
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引用次数: 4
Reaping the benefits of Open Data in public health. 获取开放数据在公共卫生方面的好处。
P Huston, V L Edge, E Bernier

Open Data is part of a broad global movement that is not only advancing science and scientific communication but also transforming modern society and how decisions are made. What began with a call for Open Science and the rise of online journals has extended to Open Data, based on the premise that if reports on data are open, then the generated or supporting data should be open as well. There have been a number of advances in Open Data over the last decade, spearheaded largely by governments. A real benefit of Open Data is not simply that single databases can be used more widely; it is that these data can also be leveraged, shared and combined with other data. Open Data facilitates scientific collaboration, enriches research and advances analytical capacity to inform decisions. In the human and environmental health realms, for example, the ability to access and combine diverse data can advance early signal detection, improve analysis and evaluation, inform program and policy development, increase capacity for public participation, enable transparency and improve accountability. However, challenges remain. Enormous resources are needed to make the technological shift to open and interoperable databases accessible with common protocols and terminology. Amongst data generators and users, this shift also involves a cultural change: from regarding databases as restricted intellectual property, to considering data as a common good. There is a need to address legal and ethical considerations in making this shift. Finally, along with efforts to modify infrastructure and address the cultural, legal and ethical issues, it is important to share the information equitably and effectively. While there is great potential of the open, timely, equitable and straightforward sharing of data, fully realizing the myriad of benefits of Open Data will depend on how effectively these challenges are addressed.

开放数据是一场广泛的全球运动的一部分,这场运动不仅推动了科学和科学交流,而且改变了现代社会和决策方式。从呼吁开放科学和在线期刊的兴起开始,已经扩展到开放数据,前提是如果数据报告是公开的,那么生成的或支持的数据也应该是公开的。在过去的十年里,开放数据取得了许多进步,主要是由政府带头的。开放数据的真正好处不仅仅是单个数据库可以更广泛地使用;这些数据也可以被利用、共享,并与其他数据相结合。开放数据促进了科学合作,丰富了研究,提高了决策的分析能力。例如,在人类和环境健康领域,访问和组合各种数据的能力可以促进早期信号检测,改进分析和评估,为计划和政策制定提供信息,提高公众参与能力,提高透明度,提高问责制。然而,挑战依然存在。需要大量的资源来实现向开放和可互操作的数据库的技术转变,这些数据库可以使用通用协议和术语访问。在数据生成器和用户中,这种转变还涉及一种文化变化:从将数据库视为受限制的知识产权,到将数据视为共同利益。在进行这一转变时,需要考虑到法律和道德因素。最后,在努力修改基础设施和解决文化、法律和道德问题的同时,公平有效地共享信息也很重要。尽管开放、及时、公平和直接共享数据具有巨大潜力,但充分实现开放数据的无数好处将取决于如何有效应对这些挑战。
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引用次数: 46
Updates to the Canadian Notifiable Disease Surveillance System and its interactive website. 加拿大法定疾病监测系统及其互动网站的更新。
S Totten, A Medaglia, S McDermott

The Canadian Notifiable Disease Surveillance System (CNDSS) provides data on diseases that have been identified as priorities for public health monitoring and control. Several advances that have been made on Notifiable Diseases Online, the CNDSS interactive website, are consistent with the Government of Canada's commitment to Open Data. This article provides an update on changes in case definitions that have been made since the case definitions were last published in 2009, and describes updates that have been made to the interactive website since 2013. Changes were made to the case definitions of five diseases. For hepatitis C, the new case definition now distinguishes between acute and chronic infection. For cyclosporiasis, the probable case definition requires an epidemiologic link, with the clarification that this would likely be due to exposure to a common food source. For rabies, the probable case definition now refers to detection of rabies-neutralizing antibody instead of specific antibody titres. For Lyme disease, the revised confirmed and probable case definitions now identify five options for Lyme disease risk areas instead of endemic areas. For tuberculosis the revised case definition now includes nucleic acid amplification testing in addition to culture for diagnosis. The Notifiable Diseases Online website is an interactive tool that enables users to create customized figures and tables. Since a major redesign in 2013, numerous changes have been made to the look and feel of the site. Figures and tables can now be extracted as Excel or PDF files and large datasets are exportable into Excel files for further analysis. Case definitions in the national surveillance system will be updated as needed and its interactive website will continue to be improved and updated in response to user comments.

加拿大法定疾病监测系统提供已被确定为公共卫生监测和控制重点的疾病数据。全国疾病预防控制系统互动网站“法定疾病在线”取得的一些进展符合加拿大政府对开放数据的承诺。本文提供了自2009年上一次发布案例定义以来案例定义变化的最新情况,并描述了自2013年以来对交互式网站的更新。对五种疾病的病例定义进行了修改。对于丙型肝炎,新的病例定义现在区分了急性和慢性感染。对于环孢子虫病,可能的病例定义需要流行病学联系,并澄清这可能是由于接触了常见的食物来源。对于狂犬病,可能病例的定义现在是指检测狂犬病中和抗体,而不是特异性抗体滴度。对于莱姆病,修订后的确诊和疑似病例定义现在确定了莱姆病风险区而不是流行区的五种选择。对于结核病,修订后的病例定义现在除了用于诊断的培养外,还包括核酸扩增检测。法定疾病在线网站是一个交互式工具,用户可以创建自定义的图表。自2013年进行重大重新设计以来,网站的外观和感觉发生了许多变化。图形和表格现在可以提取为Excel或PDF文件,大型数据集可以导出到Excel文件中进行进一步分析。国家监测系统中的病例定义将根据需要进行更新,其互动网站将继续根据用户意见进行改进和更新。
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引用次数: 2
Community outbreak of hepatitis A disproportionately affecting men who have sex with men in Toronto, Canada, January 2017-November 2018. 2017年1月至2018年11月,加拿大多伦多甲型肝炎社区爆发对男男性行为者的影响不成比例。
H. Sachdeva, M. Benusic, S. Ota, R. Stuart, J. Maclachlan, V. Dubey, A. Andonov
BackgroundIn late 2016 and early 2017, a number of countries began reporting hepatitis A virus (HAV) outbreaks involving person-to-person transmission among men who have sex with men (MSM), people using illicit drugs and homeless or underhoused persons.ObjectiveTo describe the epidemiology and public health response to an outbreak of HAV disproportionately affecting MSM in Toronto, Canada from January 2017 to November 2018.MethodsFollowing an increase in the number of cases of HAV in MSM being reported in other countries, enhanced surveillance was performed for all non-travel-related cases of HAV reported from June 1, 2017 to November 1, 2018, including a retrospective analysis of cases reported from January 2017 to June 2017. Descriptive analysis and viral sequencing were performed to describe person-to-person transmission patterns and target interventions. Control strategies included interventions to promote the uptake of preexposure HAV vaccination, including social media campaigns geared to MSM, messaging to healthcare providers and vaccine clinics.ResultsBased on the outbreak case definitions, 52 confirmed and probable cases of HAV were identified. Over 80% of outbreak cases were male (n=43/52) and, among those for whom data were available, 64% (n=25/39) reported an MSM exposure. Data on hospitalization was available for 51 cases; 56% of confirmed cases (n=23/41) and 40% of probable cases (n=4/10) required hospitalization. Of the cases with serum samples that had HAV sequencing, 83% (n=30/36) had one of the three strains seen circulating in outbreaks among MSM internationally; 72% (n=26/36) were VRD_521_2016, which had been detected in recently reported European outbreaks among MSM. Targeted promotion of publicly-funded vaccination using social media platforms popular with MSM and targeted vaccine clinics were developed to promote HAV awareness and vaccine uptake among MSM.ConclusionOutbreaks of HAV, attributed to person-to-person transmission of strains of HAV that disproportionately affected MSM and were likely to have been imported from international MSM outbreaks, have now occurred in Canada. Genetic sequencing of HAV, risk factor analysis of cases, monitoring trends of vaccine coverage in high-risk groups and initiation of vaccination campaigns that address barriers to HAV preexposure vaccine coverage in the MSM population may prevent future outbreaks.
2016年底和2017年初,一些国家开始报告甲型肝炎病毒(HAV)暴发,涉及男男性行为者(MSM)、非法吸毒者和无家可归者或住房不足者之间的人际传播。目的描述2017年1月至2018年11月加拿大多伦多甲型肝炎暴发的流行病学和公共卫生应对情况。方法随着其他国家报告的MSM中HAV病例数量的增加,对2017年6月1日至2018年11月1日报告的所有非旅行相关HAV病例进行了加强监测,包括对2017年1月至2017年6月报告的病例进行回顾性分析。进行描述性分析和病毒测序以描述人与人之间的传播模式和目标干预措施。控制战略包括采取干预措施,促进接触前甲肝疫苗接种,包括针对男男性行为者的社交媒体运动,向卫生保健提供者和疫苗诊所发送信息。结果根据暴发病例定义,共发现52例甲肝确诊和疑似病例。80%以上的暴发病例为男性(n=43/52),在可获得数据的病例中,64% (n=25/39)报告曾接触过男男性接触者。有51个病例的住院数据;56%的确诊病例(n=23/41)和40%的可能病例(n=4/10)需要住院治疗。在血清样本进行甲肝病毒测序的病例中,83% (n=30/36)携带国际上在男男性行为者中暴发流行的三种毒株之一;72% (n=26/36)为VRD_521_2016,该病毒已在最近报告的欧洲MSM暴发中检测到。利用受男男性行为者欢迎的社交媒体平台和有针对性的疫苗诊所,有针对性地促进公共资助的疫苗接种,以提高男男性行为者对甲肝病毒的认识和疫苗接种。结论加拿大现已发生甲型肝炎疫情,原因是甲型肝炎毒株的人际传播,对男同性恋者的影响不成比例,可能是从国际男同性恋者疫情输入的。甲肝病毒的基因测序、病例的风险因素分析、监测高危人群疫苗覆盖率的趋势以及开展疫苗接种运动,以解决男男男性行为人群中甲肝病毒暴露前疫苗覆盖率的障碍,这些都可能预防未来的疫情。
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引用次数: 18
Surveillance of laboratory exposures to human pathogens and toxins: Canada 2018. 实验室暴露于人类病原体和毒素的监测:加拿大2018。
D. Choucrallah, L. Sarmiento, S. Ettles, F. Tanguay, M. Heisz, E. Falardeau
BackgroundThe Laboratory Incident Notification Canada (LINC) surveillance system monitors laboratory incidents reported under the Human Pathogens and Toxins Act. The year 2018 marks the third complete year of data.ObjectiveTo describe the laboratory exposure and laboratory-acquired infection incidents that occurred in Canada in 2018 compared to previous years, and then by sector, human pathogens and toxins involved, number of affected persons, incident type and root causes.MethodsLaboratory incidents that occurred in 2018 were reported through the LINC system. The number of laboratory incidents, people exposed and laboratory-acquired infections were compared to previous years, then the incidents were analyzed by sector, human pathogen or toxin involved, the type of incident, people exposed, route of exposure and root causes. Microsoft Excel 2016 was used for descriptive analysis.ResultsIn 2018, there were 89 exposure incidents to human pathogens and 235 people were exposed. There were five suspected and one confirmed laboratory-acquired infections. This was approximately twice the number of exposure incidents that were reported in 2017 (n=44) and 2016 (n=46). The highest number of exposure incidents occurred in the academic and hospital sectors, and the ratio of incidence to licences was the lowest in the private sector. The majority of incidents (n=50; 56%) involved Risk Group 2 human pathogens that were manipulated in a Containment Level 2 laboratory. Most exposures were related to sharps or procedures and the most common people exposed were laboratory technicians. Human interaction and standard operating procedures were the leading root causes.ConclusionAlthough overall the annual incidence of laboratory exposures in Canada remains relatively low, the incidence was higher in 2018 than in previous years. Whether this is a true increase in incidence or an increase in reporting is not known at this time as baseline estimates are still being established.
加拿大实验室事件通报(LINC)监测系统监测根据《人类病原体和毒素法》报告的实验室事件。2018年是该数据的第三个完整年份。目的比较2018年加拿大发生的实验室暴露和实验室获得性感染事件,并按部门、涉及的人类病原体和毒素、受影响人数、事件类型和根本原因进行分类。方法通过LINC系统报告2018年发生的实验室事件。将实验室事件数量、暴露人员数量和实验室获得性感染数量与往年进行比较,然后按部门、涉及的人类病原体或毒素、事件类型、暴露人员、暴露途径和根本原因对事件进行分析。使用Microsoft Excel 2016进行描述性分析。结果2018年共发生人致病菌暴露事件89起,暴露人数235人。有5例疑似感染和1例确诊实验室获得性感染。这大约是2017年(n=44)和2016年(n=46)报告的暴露事件数量的两倍。接触事件发生在学术和医院部门的数量最多,私营部门的发生率与许可证的比率最低。大多数事件(n=50;56%)涉及在2级控制实验室中处理的2级危险组人类病原体。大多数暴露与利器或程序有关,最常见的暴露者是实验室技术人员。人与人之间的互动和标准操作程序是主要的根本原因。结论尽管加拿大实验室暴露的年总体发生率仍然相对较低,但2018年的发生率高于往年。目前尚不清楚这是发病率的真正增加还是报告数量的增加,因为基线估计仍在确定中。
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引用次数: 8
Use of a case-control study and control bank to investigate an outbreak of locally acquired cyclosporiasis in Canada, 2016. 使用病例对照研究和对照库调查2016年加拿大当地获得性环孢子虫病暴发。
V. Morton, K. Meghnath, M. Gheorghe, A. Fitzgerald-Husek, J. Hobbs, L. Honish, S. David
BackgroundCyclospora is an intestinal parasite that is not endemic in Canada. However, national outbreaks of locally acquired cases have been reported since 2013. These outbreaks were suspected to be associated with consumption of produce imported from countries where Cyclospora is endemic. Identification of the source can be challenging because of reporting delays and limited traceability of produce.ObjectiveTo report on a national outbreak of locally acquired cyclosporiasis, highlight the challenges of investigating these outbreaks and document the first time use of a control bank to recruit controls for a national outbreak case-control study in Canada.MethodsCases of cyclosporiasis were identified through provincial laboratory testing and reported through provinces to the national level. Cases were interviewed about food exposures using a questionnaire and food exposures reported by cases were compared to Foodbook reference values. To narrow down the food items of interest, a matched case-control study was conducted. Controls for the study were recruited primarily from a control bank, that is, a list of individuals who had previously agreed to participate in public health-related surveys.ResultsIn total, 87 cases of locally acquired cyclosporiasis with onset or report dates between May 19, 2016 and August 10, 2016 were reported by four provinces. Comparing case exposures to Foodbook reference values identified several food items of interest, including blackberries, other berries, herbs and leafy greens. The case-control study identified only blackberries and mesclun greens as significantly more frequently consumed by cases than controls. Due to lack of product details for blackberries and mesclun greens, the source of the outbreak was not conclusively identified.ConclusionBlackberries were the primary food item of interest, but could not be identified as the conclusive source due to lack of traceability. The control bank was found to be a useful tool for control recruitment.
背景环孢子虫是一种肠道寄生虫,在加拿大并不是地方性的。然而,自2013年以来,据报告在全国暴发了当地获得性病例。怀疑这些暴发与食用从环孢子虫流行国家进口的农产品有关。由于报告延迟和产品的可追溯性有限,确定来源可能具有挑战性。目的报告一起地方性获得性环孢子虫病的全国性暴发,强调调查这些暴发所面临的挑战,并记录加拿大首次使用对照库为全国性暴发病例对照研究招募对照者。方法采用省级实验室检测方法对环孢子虫病病例进行鉴定,并通过各省上报至国家一级。使用问卷对病例进行食物暴露情况访谈,并将病例报告的食物暴露情况与《食物手册》参考值进行比较。为了缩小感兴趣的食物项目,进行了匹配的病例对照研究。研究的对照主要是从对照库中招募的,即先前同意参加公共健康相关调查的个人名单。结果2016年5月19日至2016年8月10日,4个省共报告发病或报告日期为本地获得性环孢子虫病87例。将病例暴露与《食物手册》参考值进行比较,确定了几种感兴趣的食物,包括黑莓、其他浆果、草药和绿叶蔬菜。病例对照研究发现,只有黑莓和青绿色蔬菜的食用频率明显高于对照组。由于缺乏黑莓和青菜的产品细节,疫情的来源尚未最终确定。结论黑莓是研究的主要食品,但由于缺乏可追溯性,无法确定其来源。对照库被认为是对照招募的有用工具。
{"title":"Use of a case-control study and control bank to investigate an outbreak of locally acquired cyclosporiasis in Canada, 2016.","authors":"V. Morton, K. Meghnath, M. Gheorghe, A. Fitzgerald-Husek, J. Hobbs, L. Honish, S. David","doi":"10.14745/ccdr.v45i09a01","DOIUrl":"https://doi.org/10.14745/ccdr.v45i09a01","url":null,"abstract":"Background\u0000Cyclospora is an intestinal parasite that is not endemic in Canada. However, national outbreaks of locally acquired cases have been reported since 2013. These outbreaks were suspected to be associated with consumption of produce imported from countries where Cyclospora is endemic. Identification of the source can be challenging because of reporting delays and limited traceability of produce.\u0000\u0000\u0000Objective\u0000To report on a national outbreak of locally acquired cyclosporiasis, highlight the challenges of investigating these outbreaks and document the first time use of a control bank to recruit controls for a national outbreak case-control study in Canada.\u0000\u0000\u0000Methods\u0000Cases of cyclosporiasis were identified through provincial laboratory testing and reported through provinces to the national level. Cases were interviewed about food exposures using a questionnaire and food exposures reported by cases were compared to Foodbook reference values. To narrow down the food items of interest, a matched case-control study was conducted. Controls for the study were recruited primarily from a control bank, that is, a list of individuals who had previously agreed to participate in public health-related surveys.\u0000\u0000\u0000Results\u0000In total, 87 cases of locally acquired cyclosporiasis with onset or report dates between May 19, 2016 and August 10, 2016 were reported by four provinces. Comparing case exposures to Foodbook reference values identified several food items of interest, including blackberries, other berries, herbs and leafy greens. The case-control study identified only blackberries and mesclun greens as significantly more frequently consumed by cases than controls. Due to lack of product details for blackberries and mesclun greens, the source of the outbreak was not conclusively identified.\u0000\u0000\u0000Conclusion\u0000Blackberries were the primary food item of interest, but could not be identified as the conclusive source due to lack of traceability. The control bank was found to be a useful tool for control recruitment.","PeriodicalId":94304,"journal":{"name":"Canada communicable disease report = Releve des maladies transmissibles au Canada","volume":"13 1","pages":"225-229"},"PeriodicalIF":0.0,"publicationDate":"2019-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82206796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Shiga toxin-producing Escherichia coli in British Columbia, 2011-2017: Analysis to inform exclusion guidelines. 2011-2017年不列颠哥伦比亚省产志贺毒素大肠杆菌:为排除指南提供信息的分析
K. Noftall, K. Noftall, M. Taylor, L. Hoang, L. Hoang, E. Galanis, E. Galanis
BackgroundShiga toxin-producing Escherichia coli (STEC) can cause severe illness including bloody diarrhea and hemolytic-uremic syndrome (HUS) through the production of Shiga toxins 1 (Stx1) and 2 (Stx2). E. coli O157:H7 was the most common serotype detected in the 1980s to 1990s, but improvements in laboratory methods have led to increased detection of non-O157 STEC. Non-O157 STEC producing only Stx1 tend to cause milder clinical illness. Exclusion guidelines restrict return to high-risk work or settings for STEC cases, but most do not differentiate between STEC serogroups and Stx type.ObjectiveTo analyze British Columbia (BC) laboratory and surveillance data to inform the BC STEC exclusion guideline.MethodsFor all STEC cases reported in BC in 2011-2017, laboratory and epidemiological data were obtained through provincial laboratory and reportable disease electronic systems, respectively. Incidence was measured for all STEC combined as well as by serogroup. Associations were measured between serogroups, Stx types and clinical outcomes.ResultsOver the seven year period, 984 cases of STEC were reported. A decrease in O157 incidence was observed, while non-O157 rates increased. The O157 serogroup was significantly associated with Stx2. Significant associations were observed between Stx2 and bloody diarrhea, hospitalization and HUS.ConclusionThe epidemiology of STEC has changed in BC as laboratories increasingly distinguish between O157 and non-O157 cases and identify Stx type. It appears that non-O157 cases with Stx1 are less severe than O157 cases with Stx2. The BC STEC exclusion guidelines were updated as a result of this analysis.
产志贺毒素的大肠杆菌(STEC)可通过产生志贺毒素1 (Stx1)和2 (Stx2)导致严重疾病,包括血性腹泻和溶血性尿毒症综合征(HUS)。大肠杆菌O157:H7是20世纪80年代至90年代检测到的最常见血清型,但实验室方法的改进导致非O157产志贺毒素大肠杆菌的检测增加。非o157产STEC只产生Stx1倾向于引起较轻的临床疾病。排除指南限制产志贺毒素大肠杆菌病例返回高风险工作或环境,但大多数不区分产志贺毒素大肠杆菌血清组和Stx型。目的分析不列颠哥伦比亚省(BC)实验室和监测数据,为BC省产志贺毒素大肠杆菌排除指南提供依据。方法对2011-2017年BC省报告的所有产志贺毒素大肠杆菌病例,分别通过省级实验室和报告性疾病电子系统获取实验室和流行病学数据。测量所有产志贺毒素大肠杆菌合并的发病率以及血清组。测定血清组、Stx型和临床结果之间的相关性。结果7年间共报告产志贺毒素大肠杆菌984例。O157的发病率下降,而非O157的发病率上升。O157血清组与Stx2显著相关。Stx2与出血性腹泻、住院和溶血性尿毒综合征有显著相关性。结论随着实验室越来越多地区分O157和非O157病例并确定Stx型,BC省STEC的流行病学发生了变化。非O157型Stx1病例的严重程度似乎低于O157型Stx2病例。该分析结果更新了BC产志在大肠杆菌排除指南。
{"title":"Shiga toxin-producing Escherichia coli in British Columbia, 2011-2017: Analysis to inform exclusion guidelines.","authors":"K. Noftall, K. Noftall, M. Taylor, L. Hoang, L. Hoang, E. Galanis, E. Galanis","doi":"10.14745/ccdr.v45i09a03","DOIUrl":"https://doi.org/10.14745/ccdr.v45i09a03","url":null,"abstract":"Background\u0000Shiga toxin-producing Escherichia coli (STEC) can cause severe illness including bloody diarrhea and hemolytic-uremic syndrome (HUS) through the production of Shiga toxins 1 (Stx1) and 2 (Stx2). E. coli O157:H7 was the most common serotype detected in the 1980s to 1990s, but improvements in laboratory methods have led to increased detection of non-O157 STEC. Non-O157 STEC producing only Stx1 tend to cause milder clinical illness. Exclusion guidelines restrict return to high-risk work or settings for STEC cases, but most do not differentiate between STEC serogroups and Stx type.\u0000\u0000\u0000Objective\u0000To analyze British Columbia (BC) laboratory and surveillance data to inform the BC STEC exclusion guideline.\u0000\u0000\u0000Methods\u0000For all STEC cases reported in BC in 2011-2017, laboratory and epidemiological data were obtained through provincial laboratory and reportable disease electronic systems, respectively. Incidence was measured for all STEC combined as well as by serogroup. Associations were measured between serogroups, Stx types and clinical outcomes.\u0000\u0000\u0000Results\u0000Over the seven year period, 984 cases of STEC were reported. A decrease in O157 incidence was observed, while non-O157 rates increased. The O157 serogroup was significantly associated with Stx2. Significant associations were observed between Stx2 and bloody diarrhea, hospitalization and HUS.\u0000\u0000\u0000Conclusion\u0000The epidemiology of STEC has changed in BC as laboratories increasingly distinguish between O157 and non-O157 cases and identify Stx type. It appears that non-O157 cases with Stx1 are less severe than O157 cases with Stx2. The BC STEC exclusion guidelines were updated as a result of this analysis.","PeriodicalId":94304,"journal":{"name":"Canada communicable disease report = Releve des maladies transmissibles au Canada","volume":"10 1","pages":"238-243"},"PeriodicalIF":0.0,"publicationDate":"2019-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72677830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
Molecular surveillance of hepatitis C virus genotypes identifies the emergence of a genotype 4d lineage among men in Quebec, 2001-2017. 2001-2017年魁北克省男性丙型肝炎病毒基因型分子监测发现基因型4d谱系的出现。
DG Murphy, R. Dion, M. Simard, ML Vachon, Valérie Martel-Laferrière, B. Serhir, J. Longtin
BackgroundMolecular phylogenetics are generally used to confirm hepatitis C virus (HCV) transmission events. In addition, the Laboratoire de santé publique du Québec (LSPQ) has been using molecular phylogenetics for surveillance of HCV genotyping since November 2001.ObjectivesTo describe the emergence of a specific lineage of HCV genotype 4d (G4d) and its characteristics using molecular phylogenetics as a surveillance tool for identifying HCV strain clustering.MethodsThe LSPQ prospectively applied Sanger sequencing and phylogenetic analysis to determine the HCV genotype on samples collected from November 2001 to December 2017. When a major G4d cluster was identified, demographic information, HIV-infection status and syphilis test results were analyzed.ResultsPhylogenetic analyses performed on approximately 22,000 cases identified 122 G4d cases. One major G4d cluster composed of 37 cases was singled out. Two cases were identified in 2010, 10 from 2011-2014 and 25 from 2015-2017. Cases in the cluster were concentrated in two urban health regions. Compared to the other G4d cases, cluster cases were all male (p<0.001) and more likely to be HIV-positive (adjusted risk ratio: 4.4; 95% confidence interval: 2.5-7.9). A positive syphilis test result was observed for 27 (73%) of the cluster cases. The sequences in this cluster and of four outlier cases were located on the same monophyletic lineage as G4d sequences reported in HIV-positive men who have sex with men (MSM) in Europe.ConclusionMolecular phylogenetics enabled the identification and surveillance of ongoing transmission of a specific HCV G4d lineage in HIV-positive and HIV-negative men in Quebec and its cross-continental spread. This information can orient intervention strategies to avoid transmission of HCV in MSM.
分子系统遗传学通常用于确认丙型肝炎病毒(HCV)传播事件。此外,自2001年11月以来,qu公共实验室(LSPQ)一直在使用分子系统遗传学监测HCV基因分型。目的研究HCV基因型4d (G4d)特异性谱系的出现及其特征,并用分子系统发育学作为HCV株聚类鉴定的监测工具。方法LSPQ对2001年11月至2017年12月采集的样本进行前瞻性Sanger测序和系统发育分析,确定HCV基因型。当确定一个主要的G4d集群时,对人口统计信息、hiv感染状况和梅毒检测结果进行分析。结果对22000例患者进行系统发育分析,鉴定出122例G4d病例。选出了一个由37个病例组成的主要G4d集群。2010年2例,2011-2014年10例,2015-2017年25例。聚集性病例集中在两个城市卫生区。与其他G4d病例相比,聚集性病例均为男性(p<0.001), hiv阳性的可能性更大(校正风险比:4.4;95%置信区间:2.5-7.9)。聚集性病例中梅毒检测阳性27例(73%)。该聚类和4个异常病例的序列与欧洲hiv阳性男男性行为者(MSM)报告的G4d序列位于同一单系谱系上。结论分子系统遗传学能够识别和监测魁北克hiv阳性和hiv阴性男性中特定HCV G4d谱系的持续传播及其跨大陆传播。这些信息可以指导干预策略以避免HCV在男男性行为者中的传播。
{"title":"Molecular surveillance of hepatitis C virus genotypes identifies the emergence of a genotype 4d lineage among men in Quebec, 2001-2017.","authors":"DG Murphy, R. Dion, M. Simard, ML Vachon, Valérie Martel-Laferrière, B. Serhir, J. Longtin","doi":"10.14745/ccdr.v45i09a02","DOIUrl":"https://doi.org/10.14745/ccdr.v45i09a02","url":null,"abstract":"Background\u0000Molecular phylogenetics are generally used to confirm hepatitis C virus (HCV) transmission events. In addition, the Laboratoire de santé publique du Québec (LSPQ) has been using molecular phylogenetics for surveillance of HCV genotyping since November 2001.\u0000\u0000\u0000Objectives\u0000To describe the emergence of a specific lineage of HCV genotype 4d (G4d) and its characteristics using molecular phylogenetics as a surveillance tool for identifying HCV strain clustering.\u0000\u0000\u0000Methods\u0000The LSPQ prospectively applied Sanger sequencing and phylogenetic analysis to determine the HCV genotype on samples collected from November 2001 to December 2017. When a major G4d cluster was identified, demographic information, HIV-infection status and syphilis test results were analyzed.\u0000\u0000\u0000Results\u0000Phylogenetic analyses performed on approximately 22,000 cases identified 122 G4d cases. One major G4d cluster composed of 37 cases was singled out. Two cases were identified in 2010, 10 from 2011-2014 and 25 from 2015-2017. Cases in the cluster were concentrated in two urban health regions. Compared to the other G4d cases, cluster cases were all male (p<0.001) and more likely to be HIV-positive (adjusted risk ratio: 4.4; 95% confidence interval: 2.5-7.9). A positive syphilis test result was observed for 27 (73%) of the cluster cases. The sequences in this cluster and of four outlier cases were located on the same monophyletic lineage as G4d sequences reported in HIV-positive men who have sex with men (MSM) in Europe.\u0000\u0000\u0000Conclusion\u0000Molecular phylogenetics enabled the identification and surveillance of ongoing transmission of a specific HCV G4d lineage in HIV-positive and HIV-negative men in Quebec and its cross-continental spread. This information can orient intervention strategies to avoid transmission of HCV in MSM.","PeriodicalId":94304,"journal":{"name":"Canada communicable disease report = Releve des maladies transmissibles au Canada","volume":"11 1","pages":"230-237"},"PeriodicalIF":0.0,"publicationDate":"2019-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74594171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
期刊
Canada communicable disease report = Releve des maladies transmissibles au Canada
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